Alert: DWC Retroactively Updates CA OMFS

February 3, 2020 3 min read

By: Catherine Montgomery

Alert: DWC Retroactively Updates CA OMFS

Last Thursday, January 30, 2020, the California Division of Workers’ Comp (DWC) released a retroactive change to the 2020 Physician Fee Schedule. Announced in Newsline #2020-07, this is a correction to previous updates and applies retroactively to dates of service on or after January 1, 2020.

The Newsline explains that the DWC adopted Centers for Medicare and Medicaid (CMS) corrections to its Geographic Practice Cost Index (GPCI) data. These GPCIs are used to calculate workers’ comp fee schedule reimbursements for physician and non-physician medical treatment and services. Most importantly, the corrections apply retroactively to all Physician Fee Schedule reimbursements for dates of service on or after January 1, 2020.

To learn more about GPCIs and how these values are used to calculate Physician Fee Schedule reimbursements, watch our most recent free webinar: #56 - CA OMFS Overview + Part 1 of 2020 Updates: Physician and DMEPOS Fee Schedules.

With this DWC announcement, DaisyBill immediately updated our billing software to reflect the new expected fee schedule reimbursements.

The table below provides an analysis of the GPCI correction and is organized by locality. The ‘% Diff’ column calculates the percentage differences in the originally adopted 2020 GPCI values as compared to the new GPCI values that the DWC adopted last Thursday.

Of the 32 localities in California, the following 7 localities were not affected by the GPCI corrections:

SAN FRANCISCO-OAKLAND-HAYWARD (SAN FRANCISCO CNTY)
SAN FRANCISCO-OAKLAND-HAYWARD (SAN MATEO CNTY)
SAN FRANCISCO-OAKLAND-HAYWARD (ALAMEDA/CONTRA COSTA CNTY)
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY)
OXNARD-THOUSAND OAKS-VENTURA
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES CNTY)
LOS ANGELES-LONG BEACH-ANAHEIM (ORANGE CNTY)

The remaining 25 localities were affected; some locality reimbursements changed by mere pennies while other localities experienced a more significant reimbursement change.

Locality Number	Locality Name	2020 PW GPCI 1/30/2020 Retroactively Adopted	2020 PE GPCI 1/30/2020 Retroactively Adopted	2020 MP GPCI 1/30/2020 Retroactively Adopted	% Diff	PW Diff	% Diff	PE Diff	% Diff	MP Diff
51	NAPA	1.049	1.238	0.496	-1.43%	-0.015	-3.72%	-0.046	1.21%	0.006
52	SAN FRANCISCO-OAKLAND-HAYWARD (MARIN CNTY)	1.068	1.299	0.481	-0.37%	-0.004	-1.15%	-0.015	4.16%	0.02
53	VALLEJO-FAIRFIELD	1.049	1.238	0.496	-1.43%	-0.015	-3.72%	-0.046	1.21%	0.006
54	BAKERSFIELD	1.032	1.07	0.677	-0.10%	-0.001	-1.31%	-0.014	0.44%	0.003
55	CHICO	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009
56	FRESNO	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009
57	HANFORD-CORCORAN	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009
58	MADERA	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009
59	MERCED	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009
60	MODESTO	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009
61	REDDING	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009
62	RIVERSIDE-SAN BERNARDINO-ONTARIO	1.024	1.07	0.83	-0.29%	-0.003	-1.31%	-0.014	0.36%	0.003
63	SACRAMENTO--ROSEVILLE--ARDEN-ARCADE	1.033	1.078	0.58	-0.10%	-0.001	-0.56%	-0.006	1.55%	0.009
64	SALINAS	1.051	1.112	0.58	-0.10%	-0.001	-0.45%	-0.005	1.55%	0.009
65	SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY)	1.072	1.279	0.58	-0.09%	-0.001	-0.39%	-0.005	1.55%	0.009
66	SANTA CRUZ-WATSONVILLE	1.038	1.16	0.58	-0.10%	-0.001	-0.34%	-0.004	1.55%	0.009
67	SANTA ROSA	1.038	1.142	0.58	-0.10%	-0.001	-0.35%	-0.004	1.55%	0.009
68	STOCKTON-LODI	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009
69	VISALIA-PORTERVILLE	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009
70	YUBA CITY	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009
71	EL CENTRO	1.024	1.07	0.606	-0.29%	-0.003	-1.31%	-0.014	0.50%	0.003
72	SAN DIEGO-CARLSBAD	1.032	1.13	0.607	-0.10%	-0.001	-0.44%	-0.005	0.49%	0.003
73	SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE	1.024	1.083	0.58	-0.29%	-0.003	-0.37%	-0.004	1.55%	0.009
74	SANTA MARIA-SANTA BARBARA	1.035	1.14	0.58	-0.10%	-0.001	-0.44%	-0.005	1.55%	0.009
75	REST OF CALIFORNIA	1.024	1.07	0.58	-0.29%	-0.003	-1.31%	-0.014	1.55%	0.009

DaisyBill’s Fee Schedule Calculator, the foundational tool of our DaisyWizard, automatically calculates reimbursements using the most recent Medicare files and DWC reimbursement formulas. Also, if you ever need to look up a historical rate, simply enter the date of service and billing code, then voila! Your expected reimbursement awaits you in all its mathematically accurate glory.

TRY THE DAISYWIZARD

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